Foothill Surgical Specialists Medical Group

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

FOOTHILL SURGICAL SPECIALISTS MEDICAL GROUP

Practice address

1560 E. Chevy Chase Dr.
Suite 430
Glendale, CA 91206-4197

Phone

(818) 243-1135

Fax

(818) 243-9332

NPI assigned

Feb 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel H. Carvajal Jr., MDNPI 1932205721

Title

President/MD

Phone

(818) 243-1135

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel H. Carvajal, MD

  • Surgery Physician
  • Glendale, CA
  • NPI 1932205721
  NPD (past) Authorized official
• Sherin K Shirazi, M.D.

  • Surgical Oncology Physician
  • Pasadena, CA
  • NPI 1659438984

  Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389139200000",
    "number": "1760525752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E. CHEVY CHASE DR.",
            "address_2": "SUITE 430",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064197",
            "telephone_number": "818-243-1135",
            "fax_number": "818-243-9332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 E. CHEVY CHASE DR.",
            "address_2": "SUITE 430",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064197",
            "telephone_number": "818-243-1135",
            "fax_number": "818-243-9332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILL SURGICAL SPECIALISTS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2014-01-08",
        "status": "A",
        "authorized_official_last_name": "CARVAJAL",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT/MD",
        "authorized_official_telephone_number": "818-243-1135",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruth Alison Fong
• William A. Fong, D.D.S.
• Foot and Ankle Wellness Clinic
• Foothill Emergency Physicians
• Foothill Ranch Surgery & Medical Center, Inc.
• For All Hospice
• Forever Active Cbas
• Forever Active Inc
• Maryellen Forman
• Juliet Formeloza

• Surgery Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.